Lecture 22: Human Genitalia Flashcards Preview

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Flashcards in Lecture 22: Human Genitalia Deck (44):
1

Male and Female Peritoneum and Pouches

Males: 1x peritoneal pouches
1. Vesicorectal pouch: shallow, potential site for fluid to collect
Females: 2x peritoneal pouches
1. Vesicouterine pouch (anterior)
2. Pouch of Douglas/ Rectouterine pouch: deeps, extends to back of uterus--> until where vagina meets cervix. Fluid can pool --> spontaneously drain into vagina (or vagina drain into Pouch of Douglas)

2

State of Peritoneum in pelvic cavity

Peritoneum:
-continuous in the pelvic cavity
- located ontop of pelvic viscera
--> allows pouches to be created

3

Clinical relevance of Pouch of Douglas re fluid collecting

Pouch of Douglas/Rectouterine pouch is deep --> extends right behind uterus --> until where the vagina reaches the cervix
Therefore if fluid collects here (in this peritoneal pouch) --> risk of spontaneous leakage into vagina (and vice versa)

4

Clinical relevance of Pouch of Douglas re Surgery to remove abdominal tumour/infection

Abdominal Tumour infection
- Dont want abdominal scar from Colicysectomy --> access abdominal cavity re Pouch of Douglas/Rectouterine pouch --> Remove gallbladder

5

Perineal Musculature

1. Ischiocavernosa:
- attached to Ishiopubic rami + Partially to pubic symphysis
- Males: Aids erections. Females: Tenses Vagina
2. Bulbospongiosum:
- attached to Perineal body

6

Male Bulbospongiosum Structure and function

Forms Penis therefore --> combines/attaches at Midline Raphe --> forms Singular muscle
Function:
1. Erection
2. Ejaculation
3. Increases pressure in horizontal part of urethra --> aids Micturition (urination)

7

Female Bulbospongiosum Structure and Function

Forms Labia of Vagina --> Split either side of the vaginal orifice
Function:
1. Clitoral erection
2. Feelings of orgasm

8

Female Erectile Tissue

Located Posterior to Perineal Musculature and follows similar pattern
1. Crus of clitoris: (body of clitoris)
- attaches onto ischial pubic ramus + perineal membrane
- sweeps up to pubic symphysis --> detaches to form body of clitoris
2. Bulb of vestibule: a) Head clitoris b) surrounds vaginal orifice

9

Male Erectile Tissue

Located Posterior to Perineal Musculature. Follows similar pattern
Both Crus and Bulb Transfer names as go from urogenital triangle --> form penile structures
- as in males, erectile tissue detaches to become something else
1. Crus of Penis --> once detached/dorsal become Corpus cavernosa of penis (2x)
2. Bulb of penis --> becomes 1x Corpus Spongiosum + Glans Penis (which contains spongy urethra)

10

Vasculature of the Penis

2x Dorsal arteries + 2x Dorsal nerves of penis
1x Deep dorsal vein (b/w ^)
2x Deep (cavernous) artery
Note: Dorsal arteries, nerves + Deep dorsal veins = Below deep fascia of penis
Note: Deep cavernous artery inside Corpus cavernosa
vs Urethra inside Corpus spongiosum
Note: (3x) Superficial dorsal veins of penis = under superficial fascia
Note: ALL arteries/veins in penis = branches of Internal pudendal

11

Gender differences b/w vasculature of the penis

Females have the same, but all are smaller (have shorter courses)

12

How does the Deep dorsal vein of the penis (located b/w dorsal arteries) enter the penis?

Via deficit in peroneal membrane --> vesicular plexus around prostate and bladder

13

Scrotum

Inguinal canal/spermatic cord --> continues into the scrotum of the testes --> creates an outpouching of the skin of the abdominal wall
Scrotum = formed as testes leave the body
Therefore: inner layers of scrotum = same as spermatic cord
Blood supply: branches of Internal (& External) Pudendal arteries

14

Contents of the scrotum

Lower end of spermatic cord
Epididymis
Testes

15

Fascial changes in the scrotum

Abdominal Superficial Scarpa's fascia --> continuous with Superficial testicular fascia --> fat replaced by smooth muscle --> Dartos fascia
Dartos fascia (smooth muscular superficial fascia) --> continues posteriorly with Colle fascia (deep fascia of perineum)

16

Function of Cremaster muscle

Raise testes and scrotum.
Aiding:
1. Warmth
2. Protection

17

Embryonic formation of the scrotum

Mesenchymal cells condense --> form gubernaculum (still undifferentiated tissue) in inguinal canal --> continue into labio-scrotal swelling --> scrotum remains bound by gubernaculum
At end: Scrotum severes of its connection with the peritoneal cavity --> amkes it harder for structures to herniate through

18

Gubernaculum in Males and Females

Males: testes descend through inguinal canal at 7-8 months --> through gubernaculum path --> have same covering as inguinal canal
Females: Uterus is stuck to gubernaculum --> allows ovaries to remain stuck to pelvis.
In females ROUDN LIGAMENT --> goes through inguinal canal

19

Spermatic Cord contents Review

1. Vas Deferens
2. Testicular artery: L2 aortic brach supplies --> Testes and Epididymis
3. Testicular Veins: Pampiniform plexus:
Right Testicular vein drains to --> IVC
Left Testicular vein drains to --> L renal vein
4. Lymph vessels: (travels with arteries) Para-aortic nodes at root of testicular artery L2
5. Autonomic Nerves: Sympathetic artery from testicular plexus

20

Origins of additional arteries in Spermatic cord

Arteries:
Inferior epigastric --> Cremasteric artery
Inferior vesical --> Artery of Vas Deferens
Nerves:
Genital branch of Genitofemoral nerve --> innervates cremaster muscle and skin of scrotum

21

Testes

Create sperm (spermatogenesis)
Tunia Albuiginea: Tough outer fibrous capsule
Made up of Lobules --> each lobule contains 1-2 Seminiferous Tubules --> open into Rete Testis --> Efferent Tubules --> Epididymis(sperm storage) --> Vas deferens

22

Temperature of testes

3 degree cooler < abdomen
Cooling is aided by:
1. Dartos fascia (abd. Scarpa fascia fat replaced with muscle --> decreased insulation)
2. Cremaster muscle (allows testes to hang outside)
3. Heat exchange b/w artery and veins

23

Male Internal Genitalia attaching onto epidiymis

Vas deferens --> Ampulla(sperm) --+seminal vesicles (liquid) --> Ejaculatory duct --+urethra--> Prostatic urethra

24

Vas deferens

Muscular tube
Inside spermatic cord --> therefore Travels within Inguinal canal
Note: there is a vas deferens equivalent in females

25

Vas Deferen's course to the prostate

(DIR) Starts LATERAL to Inferior Epigastric artery --> Runs SUPERIORLY to External iliac vessels (passing medially towards prostate) --> Vas deferens runs SUPERIORLY to ureter(urine) --> Joins seminal vesicles --> forms ejaculatory duct which enters prostate

26

Seminal vesicles

Coiled:5cm long --> Uncoiled 10-15cm
Secrete Liquid component of ejaculate (fluid + fructose)
Note: Fructose = sugar = energy for sperm to make journey to egg
Seminal vesicle location: Posterior to bladder, Superior to prostate

27

What are the main components of the prostate gland(s)?

1. Ejaculatory duct
2. Prostatic urethra

28

Prostate gland

Inferior to bladder
Ejaculatory duct + prostatic urethra
Contains:
1. Proteolytic enzymes
2. Acid phosphotase
All arteries supplying are branches of Internal Illiac artery:
1. Internal pudendal
2. Middle rectal
3. Inferior vesicle
Veins of prostate gland:
Deep dorsal vein of penis --> vesicular plexus (good blood supply)--> Internal Illiac

29

Prostatic ligaments

Levator Prostate: "levator" = levitate = lift
Located inferior to prostate but anterior to urogenital diaphragm
Function: support prostate

30

Prostatic enlargement

Enlargement can be:
- All or partial
- Benign or malignant
Seen commonly in DR as Benign enlargement in 50+ yr old males
Outcomes:
1. Postatic enlargement (esp of median lobe) --> Herniation superiorly through sphincter from bladder -->bladder's internal sphincter vesicae unable to close properly --> urinary incontinence
2. Pocket created posteriorly in bladder near sphincter --> pool with fluid --> consistent pressure on sphincter --> continuous feeling of needing to pee

31

How do you Ultrasound a prostate?

Need to have a full bladder
- Prostate is directly inferior to bladder --> therefore need to point US directly down

32

Lymphatic Drainage of male Reproductive system

Testes: para-arotic nodes at root of testicular artery L2 (abdominal > not iliac)
Vas Deferens: External Iliac nodes
Spermatic Vesicles: External and Internal Iliac nodes
Prostate: Internal Iliac nodes
Body of Penis/Corpus Cavernosa: Internal Iliac nodes
Glans Penis: Deep Inguinal and Iliac nodes (as is superficial)
Skin of Penis + Wall of Scrotum: Superficial inguinal
- tracts with veins (recess)

33

Components of the Uterus

Vagina --> Fornix --> Cervix --> Body (endo + meso) of Uterus --> Fundus --> Isthmus --> Ampulla --> Infundibulum --> Fimbrae --> Ovaries
- ovaries arent connected to the uterine tube --> connected via Broad ligament part of uterine perotineum which sweeps overtop of the utersus
- fimbrae create current to encourage egg into uterine tube --> ectopic pregnancy
- vagina: muscular tube

34

Fornix

Recess created where vagina and cervix meet
- can access abdominal cavity

35

Creations due to Peritoneum of Uterus

1. Pouches (2x)
2. Broad Ligament (sweeps ontop, and holds ovaries externally onto uterus)
3. Uterine Angulation:
a) Bladder is inferior Supporting Uterus --> keeping it angulated and elevated --> Anteflexion --> b) Cervix --> inferior portion of uterus in direction with vagina --> Anteversion

36

Components of Broad Ligament of Uterus

- broad ligament runs through inguinal canal
- pulls uterus forward --> ontop of bladder
1. MesoVARIUM (section of broad ligament over ovary) --> a) Suspensory ligament (b/w pelvis + ovary) b) Ovarian ligament (b/w ovary + ligament)
2. MesoSALPHINX (section of broad ligament over uterine tube)
3. Round Ligament
4. MesoMETRIUM (over body) --> Double layer folded over itself

37

Sagital section of Broad ligament diagram

*****

38

Functions of Uterine Ligaments

Ligaments attached to Uterus:
1. Broad Ligaments: carries vessels, nerves + lymphatics (SI support)
2. Round ligament: Creates pot. Lymphatic pathway (superficial inguinal nodes). Anteversion to inguinal nodes
Ligaments attached to Cervix:
3. Sacrocervical --> AP support
4. Transverse cervical --> ML support
5. Pubocervical --> AP support

39

What is the uterus supported by

1. Bladder
2. Ligaments

40

Overview of ovaries

Function:
1. Ova production
2. Hormone production (Oestrogen and Progesterone) --> creates follicular cells
Arterial supply: Ovarian artery (abd. aorta L2)
Venous drainage: Ovarian venous (IVC on right + Left renal vein on Left)
Nerve: Ovarian Plexus

41

External Female genitalia

1. Clitoris (erectile tissue. female version of male penis) --> extremely/most sensitive (contains 8000 nerve endings > male penis less sensitive
2. Vestibule ( enclosed by Labia majora.) Contains:
a) opening of urethra
b) Greater Vestibular glands (produce mucus)
3. Urethral Orifice
4. Vaginal orifice

42

Female Repro Lymphatic drainage

Ovary + fallopian tube + fundus: Ovarian nodes at root of artery L2
Round ligament: Superficial inguinal nodes
Body of uterus/Broad ligament: External Iliac nodes
Cervix: Internal Iliac nodes (some sacral)
Vagina: 1. Internal Iliac nodes 2. Superficial Inguinal nodes (pathway created via round ligament)
Gonads: para-aortic L2

43

Bartholin's Glands

Greater Vestibular glands --> located in vaginal vestibule --> secrete mucus
- located posterior + Lateral to vagina
- Females version of Bulbourethral glands but in SUPERFICIAL pouch

44

Clinical relevance of Bartholin's Glands

Bartolin's Cyst
a) Bartholin glands --> blockage --> inflammation --> CYST
b) Cyst --+ (not STD) bacteria --> infection --> ABCESS
Treatment depends on severity --> cysts and abcess usually requires drainage